Does S8030 require prior authorization?

Yes, S8030 requires prior authorization (high confidence). At least one active policy explicitly requires prior authorization.

What is the Medicare reimbursement rate for S8030?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

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`S8030`, Scleral application of tantalum ring(s) for localization of lesions for proton

HCPCS/CPT

Prior Authorization

Prior Auth Required

At least one active policy explicitly requires prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

Clinical documentation of prior irradiation to the same or adjacent area and treatment planning showing the need to sculpt dose to avoid exceeding cumulative normal-tissue tolerance.
Proof of enrollment and compliance with an IRB‑approved clinical trial or a multi‑institutional patient registry that meets Medicare CED requirements (protocol/registry documentation).

Clinical documentation of tumor anatomic location and extent (e.g., periocular location, orbit/skull base/cavernous sinus invasion, intracranial extension).

Pathology, imaging, or operative reports documenting extensive perineural invasion when claimed.

Radiation treatment planning comparisons or dosimetry showing that normal tissue constraints cannot be met with photon therapy or that photon therapy would compromise standard tumor/postoperative dosing.

Documentation of treatment intent (curative) and anticipated life expectancy where applicable.

Key Coverage Criteria

Proton beam therapy (PBT) for tumors that are inoperable or when precise dose delivery is needed to minimize radiation to surrounding healthy tissue or critical structures.
Ocular tumors, including intraocular melanomas.
Primary spine or spinal cord tumors or metastatic spine/spinal cord tumors when organ-at-risk (OAR) tolerance may be exceeded with photon treatments.
Tumors at or approaching the base of the skull, including chordoma and chondrosarcoma.
Hepatocellular carcinoma and intra-hepatic biliary cancers.
Primary or benign solid tumors or other hematologic malignancies in members/enrollees aged ≤21 years.

7 Active Policies

EVICORE-HPLAN-CIGNA-AFCE721BA4F3, Cigna Comprehensive Code List - Effective 03/07/2026

EVICORE-HPLAN-CIGNA-08C913805997, Cigna Commercial Radiation Oncology Code List - Effective 03/07/2026

EVICORE-HPLAN-CIGNA_MEDICARE-A88AF85430B7, Cigna OBM Radiation Oncology Code List - Effective 01/01/2026

EVICORE-HPLAN-CIGNA_MEDICARE-0348DA3099BA, Cigna Commercial & Medicare Advantage Radiation Oncology Code List - Effective 01/01/2026

EVICORE-HPLAN-EMBLEM_GHI-8F6385AD7D76, GHI/Emblem Non-City of New York & Medicare Radiation Oncology Code List - Effective 01/01/2026

CARELON-proton-beam-therapy-2025-03-23, Proton Beam Therapy

AMBETTER-CP.MP.70, Proton and Neutron Beam Therapies

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S8030, Scleral application of tantalum ring(s) for localization of lesions for proton